The New Health Care Law and Disability

Your questions answered

Q. I am permanently disabled, in my 50s, and my Social Security disability payments push me over the eligibility line for Medicaid. But I can’t afford to buy health insurance, and some crazy rule says I must wait two years to get Medicare. By then, my deteriorating condition will be so bad, it will be too late for surgery. When will there be help for people like me?

A. Unfortunately, the new law does not change the two-year wait required before people receiving Social Security disability are eligible for Medicare coverage.

But the law does provide one new option, already in effect, that may help you and other people in this situation right now. And looking to the future, in 2014 when the main provisions of the law kick in, more help will be available for people with disabilities who are uninsured.

The new option is a federal program known as the Pre-Existing Condition Insurance Plan. If you’ve had no insurance for at least six months and have at least one medical condition that has made it impossible for you to buy coverage, this is a plan worth considering. Insurance purchased through this program may not necessarily be inexpensive (premiums vary widely among different states), but you can’t be turned down because of a health issue or disability that you already have.

Starting in 2014, the new health care law will make it easier for people who are buying insurance on their own to afford coverage. For example, it makes many more people eligible for Medicaid, including single adults under age 65. It also raises the annual income limits, so that many more people qualify for Medicaid. The law also gives states the option of expanding their Medicaid programs to cover single adults much earlier than 2014. So far, Connecticut, New Jersey and the District of Columbia have applied to the federal government to do so.

A substantial number of the people who will gain Medicaid coverage under health care reform have disabilities or chronic conditions. Medicaid is particularly well suited for these individuals because it is both affordable and comprehensive, covering a number of services that they need (such as case management and mental health care and therapy services) but that private insurance typically does not cover or covers only to a limited extent, according to the Center on Budget and Policy Priorities, a Washington think tank.

Some general provisions of the law will also bring major improvements for people with disabilities in 2014. Currently someone with a disability “has been largely shut out of the private insurance market,” says Jennifer Dexter, assistant vice president for governmental relations at Easter Seals. That will change. The law says insurers cannot deny coverage or charge more due to preexisting conditions. And Dexter says the individual and small-group coverage insurers that want to sell in new state-based insurance exchanges in 2014 will have to offer what’s called an “essential benefits package” that includes rehabilitation services and medical devices like prosthetics, crutches and wheelchairs, as well as other benefits vital to the disabled.

Medicaid has been a lifeline for people with disabilities, and too often they have had to become impoverished before they could qualify, says Dexter. Now, not only is Medicaid expanding, she says, but—equally important—it is going to shift away from institutional care as the new law requires more benefits to help people remain in their homes and communities.

The law creates the Community First Choice Option in Medicaid, which provides incentives for states to offer personal care attendants and other help at home for people with disabilities who would otherwise have to live in an institution. The services should be available late next year or in 2012.

The reform law also helps people living in institutions come home. It expands the Money Follows the Person pilot project—an experimental program that has successfully moved 6,000 disabled and older people out of institutions. It also changed the rules: Instead of requiring participants in the program to reside in an institution for at least six months before leaving, they can leave after a 90-day stay. The 20 state Medicaid agencies that don’t yet offer the program will be able to get funding to start one, said Ron Hendler, a program director at the U.S. Centers for Medicare & Medicaid Services.